Slide Anemia Aplastik

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Aplastic

Anemia



Defnition

•Pancytopenia resulting from aplasithe bone marrow

•classied into primary and secondatypes.



Defnition

• the bone marrowproduces too fewof all three types

of blood cells: redcells, white cells,and platelets(pancytopenia)



Causes

• A -Primary:

1- congenital (as Fanconis anem

!- "diopathic ac#uired ($%& ofcases).



Causes

• '- secondary:

1-chemicals (benene, toluene, glue !-drugs (chemotherapeutics, antibiophenytoin). *-insecticides. +-ioniing radiation. -infections (as hepatitis). $-paraysmal nocturnal haemoglobi



Pathophysiology

eduction in the number of haemopoietic pluripstem cells

-------/ fault in the remaining stem cells

0

"mmune reaction against stem cells.

-------/ unable to diide and di2erentiate sucieproduce the blood cells.



Clinical Features

• 3nemia with malaise, pale, and otherassociated symptoms such as palpitatio

• 4hrombocytopenia (low platelet counts)leading to increased ris5 of hemorrhagebruising and petechiae.



Clinical Features

•

6eu5openia (low white blood cell count),leading to increased ris5 of infection.

• eticulocytopenia (low reticulocyte coun

• 0ccurs at any age.



Diagnosis

• 1- 7omplete 'loodPicture (7'P): whichshows pancytopeniaand reticulocytes.

• !-'one marrow

aspirate: 8ar5edlyhypocellular marrow,due to replacementof hemopoieticmarrow by adipose

tissue (not brosis or





4o dene aplastic anemia there must be at least two of thefollowing :!

•)i(haemoglobin <10 g/dL

•)ii(platelet count 9 1;<mm;

•)iii(neutrophil count <1,5 x 10/l(.



THERAPY

1-General:

• 4he cause is remoed.

• =upportie care with blood 4ransfusion,

concentrate.

• Preention of infection.



THERAPY

2. Specifc: 3-'0?@ 830A 43?=P63?434"0?:

• 4reatment of choice.

• from B63 matcheddonor. Csually siblings.

• 6ong term surialrates: $-%&.



THERAPY

3-"88C?0=CPP@=="0?: by using drugs

• 3ntithymocyte globulin (34D)

• 3ntilymphocyte glubulin (36D)

• 7yclosporin

• "ntensie immunosupression : cyclophospham

• 7orticosteroids.



CASE REPORTObecti!eThe obecti!e o" this paper is to report a case year ol$ boy %ith a $iagnosis o" aplastic anem.

DP, a E year old boy, with 1 5gcm of 'B, came to Bai 3damBospital 8edan on 11th ?oe

1$.. Bis chief com.



History o" $isease:

DP, a E years $ months old boy, with 1 5g of 'A and 11! cmto Bai 3dam 8ali5 Deneral Bospital 8edan on 11th ?oembewith pale as chief complaint. 4he patients hae been eperie

! days before admitted to hospital.Petechie (-), hematoma (G) on the arms and legs, blac5epistais (-). Bistory of spontaneous bleeding (G) on thedays ago while feer.

Feer has been eperienced by patient since * days ago

temperature rises and drop, and was decreased by anti=hiering was not found. =eiure was not found.

Patient also eperienced malaise since ! days ago.

7yanosis (-), omiting (-) and nausea (-). Hefecation and urinormal. Bistory of weight loose is not found.



History o"pre!iousillness& Be had been

hospitalied in Bai

3dam 8ali5hospital on 3ugustand 0ctober !1

for transfusion.

History o"me$ic'ation&

3nti-pyretic drug

P7 transfusion on3ugust and0ctober !1

History o""amily&

4here is no famiyhistory of similar

disease found

Hp

m

yp

reco

o

ma7

he



Historyo"parent(sme$ic'

ation:?ot found

History o"birth&

Patient was rst child.Destational age wasaterm (*$ wee5s).

'ody weight was !Egram, body length was

not measured. 'irth

was assisted by doctor.'aby was born

normally and criedspontaneously. 'lusih

was not found.

Historyo"

immuni)ation&?ot complete

H

$

P

egrw

ba

Ph i i b d



PhysicalE*ami

nation

Presentstatus&

=ensorium : 78, body temper

B: 1 bpm, : !! <i,

'A: 1 5g, 'B: 11! cm, 'A<3'6<3: K score 9 -*, 'A<'6: K s

anemic (G), icteric (-), dyspne

(-), edema (-)

+ocali)e$status&

Bead : Face: pale

@yes : light reLe G<G, isochopupil, pale inferior palpebral

conunctia G<G, superior andpalpebra edema-<-

@ars<?ose<8outh : within normrange

?ec5 : MNP -!cmB!0 lymph n

enlargement (-)

4hora : =ymmetrical fusifor-

Ph i l : !!<i regular ronchi (G<G) wheeing ( <



PhysicalExamination

: !!<i, regular, ronchi (G<G), wheeing (-<

3bdomen: =ymmetric, supple, normal peristspleen: normal

@tremities : pulse 1 bpm regular, ade#ua

warm, 74 9 *O

Di,erentialDiagnosi

s&

3plastic anemia G 3=H

3leu5emic leu5emia G 3=H

"mmune 4rombositopenia Purpura G 3=H

-or.ing$iagnosis:

3plastic anemiaG3=H

Th P7 4ransfusion (need !1 cc)



Therapy : P7 4ransfusion (need !1 cc)

4rombosit 4ransfusion ! unit

Diagnosti

cPlanning&

7omplete blood analysis

adiology eamination

@cho eamination

+aboratory fn$ing



Test Result Unit

Hemoglobin 8.40 g%

Erythrocyte 2.50 106/mm3

Leucocyte 5.13 103/mm3

Thrombocyte 5 103/mm3

Hem!tocrite 24.20 %

Eo"ino#hil 1.00 % $!"o#hil 0.500 %

eutro#hil 2.80 %

+aboratory fn$ingComplete bloo$ analysis /00th 1o!ember2304 5 067338

T t R lt U it



Test Result Unit

Lym#hocyte 65.70 %

&onocyte 3.30 %

eutro#hil !b"olute 1.53 103/(L

Lym#hocyte !b"olute 3.37 103/(L

&onocyte !b"olute 0.17 103/(L

Eo"ino#hil !b"olute 0.05 103/(L

$!"o#hil !b"olute 0.01 103/(L

&)* 6.80 +l

&)H 33.60 ,g

&)H) 34.70 g%

Result& Anemia normo.rom normositer 9 Trombositope

Ra$iology e*amination



Result:

'oth of sinus costophrenicus are sharp. Hiafragma is smooth, ?o inltrate, 7ardiomegaly 4rachea in middle, 'ones and soft tissue normal

Ra$iology e*amination



•6arge 3=H (1-!mm)

•"nade#uate right posterior

•is5 sided enlargement

Result o" Echo e*amination



S

O en"orium )& Tem# 37)

Eye Light rele 9/9 i"ochoric #u#il #!le inerior con:uncti! #!l#eb-/-

E!r

o"e

&outh

Thor! "ymmet-

H< 8 b-

<< 22/i regul!r r-/-

>bomen "u##le #eri"t!ltic 9 Lier !n

Etremitie" #ul"e 8 b#m regul!r !e?u!te #/ A

A

P ,<) Tr!n"u"i

Answer from H

S



S

O e

Eye Light rele 9/9 i"ochoric #u#il #!le inerior con:uncti! #!l#-/-

E!

o"

&out

Thor! "ymm-

H< 10-

<< 24/i regul!r-/-

>bomen "u##le #eri"t!ltic 9 Lier !

Etremitie" #ul"e 104 b#m regul!r !e?u!te #A

A

P ,<) Tr!n"u"ion C

Trombo"i

S



S


Eye Light rele 9/9 i"ochoric #u#il #!le inerior con:uncti! #!l#e-/-

E!r

o"e

&outh

Thor! "ymme-

H< 4-

<< 20/i regul!r -/-

>bomen "u##le #eri"t!ltic 9 Lier !nEtremitie" #ul"e 4 b#m regul!r !e?u!te #/A

A

P

Biet &$

Answer from He

S



S

O en"


E!r

o"e

&outh

Thor! "ymmet-

H< 2b-

<< 22/i regul!r r-/-


Etremitie" #ul"e 2 b#m regul!r !e?u!te #/ A

A

R )om#let

+aboratory fn$ing



Test Result Unit

Hemoglobin 11.30 g%




Hem!tocrite 33.20 %

Eo"ino#hil 0.40 %

$!"o#hil 0.400 %

eutro#hil 6.60 %

Lym#hocyte 25.60 %

&onocyte 4.00 %

y g Complete bloo$ analysis /0:th 1o!ember 5 0073#8

Test Result Unit






Eo"ino#hil !b"olute 0.01 103

/(L $!"o#hil !b"olute 0.01 103/(L

&)* 3.30 +l

&)H 31.70 ,g

&)H) 34.00 g%

+erritin 727.30 ng/ml

Result& +eu.openia 9 Trombositopenia

S 9



S 9



E!r

o"e

&outh

Thor! "ymme-

H< 8-

<< 24/i regul!r -/-


Etremitie" #ul"e 8 b#m regul!r !e?u!te #/A

A

P

Biet &$

S 9



S 9

O en


E!r

o"e

&outh

Thor! "ymme-

H< 100 -

<< 25/i regul!r -/-



A

P

Biet &$

+aboratory fn$ingC l t bl $ l i /0:th 1 b



Test Result Unit

Hemoglobin 11.30 g%




Hem!tocrite 32.50 %

Eo"ino#hil 1.30 %

$!"o#hil 2.800 %

eutro#hil 21.20 %

Lym#hocyte 68.10 %

&onocyte 6.60 %

Complete bloo$ analysis /0:th 1o!ember 5 0073#8

Test Result Unit






Eo"ino#hil !b"olute 0.04 103/(L

$!"o#hil !b"olute 0.0 103/(L

&)* 5.00 +l

&)H 33.00 ,g

&)H) 34.80 g%

Result& ;isitopenia

S 9





E!r

o"e

&outh

Thor! "ymme-

H< 6-

<< 24/i regul!r -/-



A

P

Biet &$

S 9



O en"o


E!r

o"e

&outh

Thor! "ymme-

H< 6-

<< 24/i regul!r -/-



A

P

Biet &$

S




Eye Light rele 9/9 i"ochoric #u#il #!le inerior con:uncti! #!l#e-/-

E!r

o"e&outh

Thor! "ymme-

H< 6-

<< 20/i regul!r -/-



A

P

Biet &$

R





Hone by

- Farana Qhairunisa

- 3nanda Putri 4arigan

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Slide Anemia Aplastik